Welcome Back Rheumatology Fans,
Many of you will remember Mike from “Rheum Mates” which was a podcast series that we did a few years back. It is never boring chatting with him and so we discussed his PhD of all things which is on the sometimes spicy topic Hypermobility!
2017 hEDS Criteria: https://onlinelibrary.wiley.com/doi/10.1002/ajmg.c.31552
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Below is an AI Summary Of The Podcast
Mikes PhD Focus & Research Direction
* Original Aim: Investigate evidence for conservative (non-surgical, non-pharmacological) management of HSD/hEDS in adults.
* Shifted Focus: Now looking at pediatric cohorts due to a lack of robust adult RCTs.
* Adult studies are often low-quality, opinion-based, or use flawed inclusion criteria (e.g. only Beighton score).
* Pediatric studies have more rigorous RCTs with better sample sizes and clearer outcomes.
📚 Key Learnings from the Literature
* Hypermobility ≠ HSD or hEDS:Many people are hypermobile (e.g., "double-jointed") but are asymptomatic and don’t meet diagnostic criteria.
* Beighton Score Alone Is Inadequate:It doesn’t account for widespread pain or systemic symptoms—should not be used in isolation to diagnose HSD/hEDS.
* Proper Criteria Needed:Diagnosis should be based on the Brighton criteria or 2017 hEDS criteria, not just joint flexibility.
👶 Pediatrics & Early Diagnosis
* Delay in Diagnosis Is Common:Many are misdiagnosed or ignored—sometimes taking up to 15 years to get a correct diagnosis.
* Symptoms Often Multi-Systemic:Includes joint pain, dislocations, stretchy skin, fatigue, GI issues, POTS, anxiety, etc.
* Early Diagnosis Matters:Leads to better patient outcomes, validation of their symptoms, and appropriate support.
🧠 Clinical Challenges
* Heterogeneity:Two people with hypermobility can present very differently—one may function as an elite athlete, the other may be disabled.
* Unclear Why Some Develop HSD/hEDS:Genetics don’t yet explain it fully. Severity of hypermobility does not predict chronic pain or dysfunction.
🏃 Management & Treatment
* Exercise & Education Are Key:Strong evidence shows structured exercise improves pain and function.
* Two RCTs (Kemp et al. & PACL) showed general exercise programs work just as well as targeted ones in children with hEDS.
* Surgery & Medication Less Effective:Lack of evidence supporting these as primary treatment options.
* Athletes May Self-Manage by Staying Active:Gymnasts and dancers often remain asymptomatic due to regular strength and mobility training.
✅ Clinical Tips to Avoid Missing Diagnoses
* Distinguish Hypermobile Joints from HSD/hEDS:Most hypermobile individuals are healthy—don’t over-diagnose.
* Use Full Diagnostic Criteria:Don’t rely on the Baten score alone; use Brighton or 2017 hEDS criteria.
* Educate & Empower Patients:Reassure them that appropriate exercise and education can improve quality of life.
* Recognize Impact of Delay:Long-term mismanagement leads to worsening symptoms, mental health issues, and loss of function.
